Murali R. Ravel, DMD
360 NH-101, #14 Bedford, NH 03110
Dental Procedures
Preventive Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Adult Dental Cleaning | $104 | 0% | $104 | Medium |
| Child Dental Cleaning | $88 | 0% | $88 | Medium |
| Fluoride - Topical Application | $43 | 0% | $43 | Medium |
| Plaque and tartar removal from around teeth and gums-per quadrant | $275 | 0% | $275 | Medium |
| Sealant placed on the tooth surface to prevent decay | $113 | 0% | $113 | Medium |
Diagnostic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Comprehensive Dental Exam | $149 | 0% | $149 | Medium |
| Periodic dental exam - established patient | $49 | 0% | $49 | Medium |
| Problem focused evaluation limited to a specific oral health problem or complaint | $92 | 0% | $92 | Medium |
| X-Ray Dental - Complete intraoral series | $167 | 0% | $167 | Medium |
| X-Ray Dental - Four images - bitewings | $78 | 0% | $78 | Medium |
| X-Ray Dental - Intraoral - periapical radiographic image | $33 | 0% | $33 | Medium |
| X-Ray Dental - Two images - bitewings | $62 | 0% | $62 | Medium |
| X-Ray Dental - Additional image of tooth from crown to root, from inside mouth | $35 | 0% | $35 | Medium |
| X-Ray Dental - Whole mouth, from outside mouth | $179 | 0% | $179 | Medium |
Dental Fillings
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Silver (Amalgam) Dental Filling - One surface, primary or permanent | $161 | 0% | $161 | Medium |
| Silver (Amalgam) Dental Filling - Two surfaces, primary or permanent | $221 | 0% | $221 | Medium |
| Silver (Amalgam) Dental Filling - Three surfaces, primary or permanent | $306 | 0% | $306 | Medium |
| White (Resin) Dental Filling - One surface, posterior | $161 | 0% | $161 | Medium |
| White (Resin) Dental Filling - Two surfaces, posterior | $221 | 0% | $221 | Medium |
| White (Resin) Dental Filling - One surface, anterior | $156 | 0% | $156 | Medium |
| White (Resin) Dental Filling - Three surfaces, posterior | $306 | 0% | $306 | Medium |
| White (Resin) Dental Filling - Two surfaces, anterior | $195 | 0% | $195 | Medium |
Orthodontic Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Orthodontic Treatment Visit (Periodic - as part of a contract) | $118 | 0% | $118 | Medium |
Other Dental Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Maintenance Therapy - Periodontal | $150 | 0% | $150 | Medium |
| Tooth Extraction (Elevation and/or forceps removal) | $190 | 0% | $190 | Medium |